(336) Mulcahy Salvage and Penile Prosthesis Replacement via Infrapubic Approach

Abstract Introduction The Mulcahy Salvage protocol for infected penile prostheses, first described in 1996, aims to prevent fibrosis and penile shortening after delayed replacement. It proposes immediate exchange with either a definitive or temporary malleable implant following vigorous irrigation with antiseptic and antimicrobial solutions to eliminate biofilm. Reported success rates range between 80–90%, although no standardized and validated protocol currently exists. Objective The objective of using the Mulcahy salvage procedure via the infrapubic approach in penile implant revision is to effectively manage infected or malfunctioning prostheses while preserving corporal integrity and penile length. This technique enables complete removal of infected material, extensive irrigation with antibiotic solutions, and immediate reimplantation of a new device under sterile conditions. The infrapubic route offers direct access to the reservoir and cylinders, minimizing tissue trauma and operative time. The main goal is to eradicate infection, reduce fibrosis, and restore prosthetic function and patient satisfaction, avoiding the complications associated with delayed reimplantation or corporal fibrosis. Methods We present the case of a 69-year-old male with hypertension, dyslipidemia, and poorly controlled insulin-dependent diabetes mellitus, with a history of transurethral resection of the prostate (TURP) five years earlier and erectile dysfunction refractory to oral and injectable therapy. Three months after circumcision for balanitis, a three-component Titan Touch penile prosthesis was implanted via an infrapubic approach. The immediate postoperative course was uneventful. Eleven months post-surgery, the patient presented with wound drainage without swelling. Culture of the exudate revealed Candida glabrata. He received intravenous fluconazole for five days followed by two weeks of oral voriconazole plus micafungin, with partial clinical improvement but persistent positive cultures.A prosthesis replacement with a malleable implant was performed using the Mulcahy Salvage protocol through the infrapubic approach. Results At one-year follow-up, the patient showed satisfactory wound healing, good glycemic control (HbA1c 6.6%), and proper function of the malleable prosthesis, opting not to undergo implantation of a definitive three-component device. Conclusions The Mulcahy Salvage protocol represents a valuable strategy for managing penile prosthesis infections. Knowledge of different surgical approaches is essential, as the infrapubic route may offer shorter operative time and earlier recovery of sexual activity. Disclosure No